Instrument head, application instrument having said instrument head, application system and method of operating a supply system

ABSTRACT

The invention relates to an instrument head, comprising: an exit opening (23); a first feed line (11) for the feed of a first fluid; a second feed line (12) for the feed of a second fluid; a reservoir (24) for storing the fluid fed via the second feed line (12); wherein the reservoir (24) is in fluid communication with the first feed line (11) and/or is adapted to be brought in fluid communication with the first feed line (11) via at least a valve (25) arranged in the instrument head, to deliver fluid stored in the reservoir (24) via the exit opening (23).

RELATED APPLICATION(S)

This application claims the benefit of European Patent Application No.EP 14200435.7 filed Dec. 29, 2014, the contents of which areincorporated herein by reference as if fully rewritten herein.

TECHNICAL FIELD

The present invention relates to an instrument head, an applicationinstrument having said instrument head, an application system and amethod of operating a supply system for said application instrument.

BACKGROUND

Appropriate application instruments that are suitable for introducingsubstances or suspensions, in particular cells into a biological tissuehave been know. US 2001/0027296 A1, for example, describes anapplication instrument that may acquire cells from a tissue forprocessing and subsequently return them back into the tissue.

The instrument of US 2011/0282381 A1 is essentially based on that anappropriate canal is already present in the tissue, for introducing thesubstances. Occasionally, an appropriate canal may be pricked with atip. Provision of an appropriate canal results in significant damage ofthe tissue to be treated. Furthermore, with the described instrument, itis very difficult to accomplish extensive and homogenous distribution ofthe substance to be introduced.

Starting from US 2011/0282381 A1, it is thus the object of the presentinvention to provide an instrument head allowing for efficientintroduction of substances into biological tissue. With this, it isintended minimal damage of the tissue to occur and to optimizepositioning of the introduced substance. Furthermore, an extensive andhomogenous distribution of the introduced substance is to beaccomplished as far as possible, wherein the substance that for examplemay be cells is gently treated such that no damage of the substanceoccurs.

SUMMARY

In particular, the object will be solved by an instrument headcomprising:

a. an exit opening,

b. a first feed line for feeding a first fluid,

c. a second feed line for feeding a second fluid,

d. a reservoir for storing the fluid fed via the second feed line,

wherein the reservoir is in fluid communication with the first feed lineand/or is adapted to be brought in fluid communication with the firstfeed line via at least a valve that is arranged in the instrument head,to deliver fluid stored in the reservoir via the exit opening.

An application instrument for an endoscope ordinarily has an instrumenthandle at the proximal end, a preferably elastic shaft and an instrumenthead at the distal end. According to the invention, at least theinstrument head is configured in a specific manner.

A gist of the invention resides in introducing, with maximum efficiency,the substances, in particular a (cell) suspension into the tissue by ahydro-surgical instrument. For this, the instrument head according tothe invention comprises a reservoir that can temporarily store thesubstance until it will be applied via a nozzle. The distal arrangement(in the vicinity of the tip) of the reservoir results in that uponapplying pressure onto the substance, the substance may more or less bedelivered via a nozzle. In this respect, only very low loss of pressureoccurs. Furthermore, exposure time for pressure will significantly bereduced. This results in that the substance may be applied with highpressure under minimal stress. During application of cells this resultsin a very high survival rate, thus being able to accomplish a promisingtreatment result.

Due to very low loss of pressure it is also possible to introduce thesubstance relatively deep into the tissue at low stress or with lowdamage. Application of the substance by way of a water jet applicatorgenerally has the advantage that only very minor damage of the targettissue will occur and very good distribution of the substance may beaccomplished.

Preferably, the instrument head according to the invention comprises thefirst feed line and the second feed line, wherein the feed lines beardifferent fluids. In one embodiment, the first fluid is a propellant andthe second fluid is the substance or suspension to be applied. Thesecond feed line may also be utilized to fill the reservoir with thesubstance. The propellant is introduced into the reservoir via the firstfeed line, so that the substance will be expelled therefrom.Introduction may be done by way of an existing fluid communication orthrough a valve. Preferably, this valve is arranged in close vicinity tothe distal end.

In one embodiment, the at least one valve comprises at least a lockingpart for locking the first feed line from the reservoir. The lockingpart may serve for preventing the first feed line from being at leastpartially filled with fluid during introduction of the substance. It maythus be prevented that the “precious” substance will be lost.Preferably, the valve is formed such that, in a pressure-free state, thefirst feed line is locked from the reservoir. For example, the lockingpart or the valve membrane, respectively, may be formed of an elastomer.Preferably, it is a passive valve, so that the space required forarranging the valve is very low. This has the advantage that theinstrument head may be very low in diameter.

In one embodiment, the at least one valve is a shuttle valve that eitherlocks the first feed line or the second feed line from the reservoir.For this, the locking part may appropriately be accommodated. Duringapplication of the first fluid (for example of the propellant) the firstfluid may thus be prevented from entering the second feed or the secondfeed line, respectively. In this way, unwanted mixing of the first andsecond fluid in the second feed line may be prevented (substancewatering). Provision of the shuttle valve has the further advantage thatthe first fluid not only may be used as a propellant, but may also beemployed for the manufacture of a tissue canal in the biological tissue.For example, the first fluid may first be applied in a pulsed manner inorder to establish the canal. After that, the reservoir is filled withthe second fluid, and is applied again by way of the first fluid.

In this design, the shuttle valve has the further advantage that thefirst fluid for the manufacture of the tissue canal may be driven withsignificantly higher pressure without damage of the substance to beapplied to occur. The shuttle valve protects the substance fromexcessively high pressure, which occasionally may negatively affect theeffect of the substance.

In one embodiment, the exit opening comprises a valve, in particular inthe form of a flexible nozzle. A flexible nozzle body may beincorporated in the instrument head, such that predetermined pressingradially acts on the nozzle body, and in the initial state the nozzleopening is locked. If the pressure in the reservoir increases, e.g. dueto feed of the second fluid, the nozzle body first gets slightly curvedoutwardly without the exit canal being opened. Thus, a set volume amountmay be pre-dosed in the reservoir. In the following, the pre-dosedvolume may be expelled by way of the first fluid. Preferably, thematerial hardness of the flexible nozzle is selected such thatsufficient expansion is accomplished and thus accommodation of apre-dosed volume in the reservoir is accomplished. For this, preferablya pressure not exceedingly high, for example larger than 20 bar, isrequired.

Finally, a flexible nozzle may also prevent the exit opening fromgetting clogged and may assure that the second and/or first fluid isapplied with a specified minimal pressure.

In one embodiment, in the instrument head, another valve for preventingback flow of fluid is provided in the second feed line. This may be acheck valve. Said second valve may serve for maintaining a presetpressure in the reservoir, for example after introduction of the secondfluid. Furthermore, the second valve prevents the second fluid fromrunning on, as soon as active introduction of the second fluid into thesecond feed line will be suppressed. In this way, precise dosage may berealized.

The above-mentioned object will further be solved by an applicationinstrument for an endoscope, wherein the application instrumentpreferably comprises a shaft and an instrument handle in the vicinity ofor at the proximal end of the shaft. The application instrument, at theproximal end of the flexible shaft, may be provided with the alreadydescribed instrument head in one of the described embodiments.

Similar advantages to those already described in connection with theinstrument head will arise.

In one embodiment, the shaft and/or the instrument has an externaldiameter (Ad) of less than 3 mm. With the configuration of the inventionof the instrument head the object of the invention may be realized,wherein common dimensions of endoscopic instruments may be maintained.

In one embodiment, the application instrument comprises a venting devicein or on the second feed line. The venting device may be formed forventing the second feed line. For this, a shuttle valve and, asnecessary, another small reservoir may preferably be provided. A ventmay as well be provided for preventing run on. The venting device allowsventing at least part of the second feed line immediately afterintroduction of the second fluid. In this respect, the amount of theintroduced second fluid may precisely be dosed. Furthermore, the ventingdevice may enable very rapid reduction of pressure built up in thereservoir. With the application instrument according to the invention itis thus possible to pulsedly deliver the fluids, thus achieving verysteep falling edge of the pulse. This is the requirement for pulseddelivery of the fluids and for rapid switching between the deliveries offirst and/or second fluid. Furthermore, it also allows for verydeliberate delivery of the fluids. For example, in this way dosage ofthe delivered fluids may be assured.

The instrument handle may at least comprise a regulating valve orcontrol valve with a valve drive, so as to generate pulsed/sequentialpressurizing of the first feed line and/or the second feed line. Saidregulating valve facilitates pulsed fluid delivery. The regulating valveallows for defined pressurizing, wherein expansion of connection lines,for example between the application instrument and the supply system mayremain unconsidered. In this respect, with the application instrumentaccording to the invention, significantly superior results may beachieved. Said improved results will be achieved by the optimized formof the pulse and the steepness of the rising and falling edges,respectively.

The above-mentioned object will furthermore be solved by an applicationsystem. The application system preferably comprises an applicationinstrument as described above. Moreover, the application system maycomprise a supply system, which is in fluid communication at least withthe first feed line.

The supply system may be formed to convey the first fluid into the firstfeed line within a series of conveying intervals. The supply system mayalso provide at least the first fluid with suitable pressure values. Asto the application system, there are also similar advantages to thosealready described in connection with the application instrument.

The supply system may comprise the controller that controls at least onevalve, for example the regulating valve already described, such thatwithin an application time interval of less than 2 s, in particular lessthan 1 s:

the first fluid, within at least a first conveying interval, with afirst pressure in the first feed line;

the second fluid within a second conveying interval following the firstconveying interval with a second pressure in the second feed line; and

the first fluid within at least a third conveying interval with a thirdpressure, will be conveyed in the first feed line.

According to the invention the supply system may drive the first and/orsecond fluid such that the first and the second fluid are deliveredwithin very short time, and are preferably alternatingly delivered. In apreferred embodiment, immediate conveying of the second fluid in thesecond feed line occurs only for filling the already describedreservoir. Then, in the third conveying interval, the first fluid, whichserves as a propellant for expelling the second fluid from the reservoiris conveyed again. The applied third pulse level (developing the thirdpressure) is also essential in that with which pressure the second fluidis outputted.

Utilization of the first fluid not only for exposing a tissue canal butalso as a propellant may advantageously be employed in configuring theapplication instrument. For example, the first feed line may beconfigured significantly more pressure-resistant than the second feedline that is operated with a preferably significantly lower secondpressure.

The application system may comprise a pump for conveying the first fluidand a medium separation device that is arranged and formed such that thefirst fluid drives the second fluid also in the second conveyinginterval. Preferably, the supply system is utilized for conveying thefirst and second fluid in the first and the second feed line,respectively. For this, in the supply system or between the applicationinstrument and the supply system a medium separation device may beprovided providing the second fluid and driven by the first fluid. Thus,finally in the timely delayed second conveying interval, conveying thefirst fluid may be essential to driving the second fluid.

Alternatively, the medium separation device may be formed as or may bereplaced with, respectively, a second pump or fluid source,respectively. That means, conveying the second fluid into thealready-described reservoir may be done independently of the firstfluid.

The first pressure may be larger than the third pressure. Preferably,the first pressure is significantly larger than the third pressure, inparticular by at least 30%. In one embodiment, the first pressure may belarger than the third pressure by at least 100% or even by at least200%. Preferably, the first pressure is designed such that at leastpartial separation of the target tissue is possible. The first pressureserves for creating a canal for introducing the substance. In oneembodiment, the first pressure ranges between 40 and 100 bar, inparticular between 60 and 90 bar. Contrary to this, the third pressuremay for example be in the range between 1 and 40 bar, in particularbetween 2 and 20 bar. Preferably, the third pressure is selected suchthat gentle introduction of the substance is assured. Furthermore,choice of the third pressure depends on how deep the substance is to beintroduced into the tissue.

The above-mentioned object may furthermore be solved by way of a controlprocess for the operation of supply system. According to the invention,the control process may comprise the following steps:

activating a first fluid source such that a first fluid with a firstpressure during a first conveying interval is delivered;

activating a second fluid source, such that a second fluid during asecond conveying interval with a second pressure in an reservoir, inparticular a distal reservoir of an instrument, is delivered;

activating the first fluid source such that the first fluid with a thirdpressure during a third conveying interval is introduced into thereservoir to deliver the second fluid via an exit opening.

Similar advantages to those already described in view of the supplysystem arise. The control process may be employed in the context of thealready illustrated application system.

In one embodiment, the steps a through c may be performed within anapplication time interval of less than 2 s, in particular less than 1 s.In one embodiment, per second, a canal for introducing the substance isopened and an appropriate pulse for the delivery of the substance isemitted. According to the invention, it is possible that followingopening of the canal several steps of substance-delivery will beperformed. In this respect, per step a, the steps b and c may berepeated several times.

In one embodiment, this repetition is done at least three times within 2s.

Furthermore, the previously mentioned object will be solved by way of acomputer readable storage medium with instructions for theimplementation of the described control process, if the instructions areexecuted on a computing unit.

In the following, the invention will be described by way of severalillustrating examples. Wherein:

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic representation of the layered design of a holloworgan;

FIG. 2A is a schematic representation of an application instrumentaccording to a first embodiment (shuttle valve only) with fluid flowingfrom an internal feed canal;

FIG. 2B is a schematic representation of the application instrumentaccording to the first embodiment with fluid flowing from an externalfeed canal;

FIG. 3A is a schematic representation of an application instrumentaccording to a second embodiment (shuttle valve with distal check valve)with fluid flowing from the internal feed canal;

FIG. 3B is a schematic representation of the application instrumentsaccording to the second embodiment with fluid flowing from the externalfeed canal;

FIG. 4A is a schematic representation of an instrument head according toa third embodiment (a flexible nozzle) with fluid flowing from theexternal feed canal;

FIG. 4B is a schematic representation of the instrument head accordingto the third embodiment with fluid flowing from the internal feed canal;

FIG. 5 is an instrument head of a fourth embodiment (also a flexiblenozzle with cell suspension feed through the external feed canal);

FIG. 6A is a schematic representation of an application instrumentaccording to a fifth embodiment (venting device) with fluid flowing fromthe external feed canal;

FIG. 6B is a schematic representation of the application instrumentsaccording to the fifth embodiment with fluid flowing from the internalfeed canal;

FIG. 7A is a schematic representation of an application instrumentaccording to a sixth embodiment (shuttle valve with proximal check valveof a flexible element) with fluid flowing through the external feedcanal;

FIG. 7B is a detailed view of the flexible element from FIG. 7A;

FIG. 8A is a schematic representation of a first alternative embodimentof a shuttle valve at the internal feed canal;

FIG. 8B is a schematic representation of a second alternative embodimentof a shuttle valve at the internal feed canal;

FIG. 8C is a schematic representation of a third alternative embodimentof the valve seat of the shuttle valve at the internal feed canal;

FIG. 9A is a schematic representation of an application instrumentaccording to a seventh embodiment;

FIG. 9B is a detailed view of the instrument head according to FIG. 9A;

FIG. 10 is a schematic representation of a supply system according to afirst illustrating example, wherein all control valves are incorporatedin the supply system;

FIG. 11 is a schematic representation of a supply system according to asecond illustrating example, wherein a control valve is incorporated inthe application instrument;

FIG. 12 is a schematic representation of a first alternative design forthe creation of a pulsed water jet;

FIG. 13 is a schematic representation of a second alternative design forthe creation of a pulsed water jet;

FIG. 14 is a schematic representation of a third alternative design forthe creation of a pulsed water jet;

FIG. 15 is a schematic representation of a fourth alternative design forthe creation of a pulsed water jet;

FIG. 16 is a schematic representation of a fifth alternative design forthe creation of a pulsed water jet;

FIG. 17 is a pressure history generated by the supply system accordingto a first control algorithm;

FIG. 18 is a pressure history generated by the supply system accordingto a second control algorithm;

FIG. 19 is a pressure history according to FIG. 18 having additionallyindicated bypass and venting phases.

In the following description equal reference numbers will be used forequal parts.

DETAILED DESCRIPTION

FIG. 1 shows a schematic representation of the layer design of a holloworgan of the efferent urinary tracts. Essential tissue layers are themucosa 1 and the muscularis 2. The urinary tract is represented on thevery top. This is followed by an epithelium that in turn is followed bythe Lamina propria 3. In the following, the longitudinal muscle andcircular muscle 4 are represented. The application system of theinvention may be employed to assure faster regeneration of a sphincterdefect of the represented urinary tract.

The application system allows for tissue-engineering-based therapy, inwhich a suspension, for example cells in a nutrient broth, is passed tothe urethral sphincter muscle with sufficiently high survival rate ofthe cells through several tissue layers located upstream of the urethralsphincter muscle, and is deposited in the urethral sphincter muscle withthe lowest loss possible. Ideally, in doing so, damage of the stillintact sphincter muscle tissue is prevented. Hence, the circular muscle4 from FIG. 1 represents a possible target tissue for the applicationsystem of the invention, wherein the applied water jet is required tofirst perforate the Mucosa 1 in order to transport the substance to theMuscularis 2.

There are numerous alternative applicabilities for the system of theinvention, for example bile ducts, gastrointestinal walls, vessel walls,bronchial walls etc.

FIG. 2 shows a first illustrating example of an application instrument10 according to the invention. An essential component of the applicationinstrument 10 is the probe shaft 14, which preferably is at leastpartially flexible and proximally has an instrument head 20. Thisinstrument head 20 has a nozzle 23 for the delivery of fluids. Thefluids may be a saline or the already mentioned suspension with cellportions. In order to feed the fluids, an internal feed canal 21 iscoaxially arranged in the lumen of the probe shaft 14. The external areaof the internal feed canal 21 forms the external feed canal 22surrounding the internal feed canal 21. The internal feed canal 21, asit is shown in FIG. 2A, is in fluid communication with a distalreservoir 24 via the lateral openings 26. A shuttle valve 25 arranged atthe distal tip of the internal feed canal 21 allows for passing a firstfluid from the internal canal 21 into the distal reservoir 24, and locksfluid communication between the distal reservoir 24 and the externalfeed canal 22.

The internal feed canal 21 is provided with the first and second fluid,respectively via a first inlet 11, and the external feed canal 22 via asecond inlet 12.

FIG. 2B shows a detailed view of the instrument head 20 from FIG. 2A.Contrary to the representation according to FIG. 2A, the shuttle valve25 in FIG. 2B locks the lateral openings 26, so that immediate fluidcommunication between the distal reservoir 24 and the external feedcanal 22 is established.

An aspect of the present invention is to deliver the fed fluids in anapproximately perfect pulse shape via an exit opening 23, the nozzle 23.The instrument head 20 according to the invention allows delivery offluid pulses at relatively low pressures, with which the fluids maysuitably penetrate into the target tissue. Due to efficient utilizationof the present pressures the cell will be “spared” in this application.

A further aspect of the invention is to introduce, by way of controllingthe pulses, the fluids, in particular the cell suspension into differentlevels of the target tissues. Due to efficiently using the presentpressures in the application, the cell suspension may be introduced intothe target tissue “sparedly”, in particular at different locations.

For effectively introducing the suspension, within an application timeinterval, for example as it is shown in FIG. 17, the first fluid, withina first time interval T1, is first conveyed with high pressure ph.Within this first time interval T1 the instrument head 20 is in thestate, such as it is shown in FIG. 2A. The first fluid exits theinternal feed canal 21, fills the distal reservoir 24 and is deliveredvia the nozzle 23 with a defined nozzle diameter. Thus, the first fluidimpinges on the tissue with high kinetic energy and may be utilized tocreate an introduction canal. In a second time interval T2 that follows,the second fluid is driven with a very low pressure pz so that thedistal reservoir 24 becomes filled with the second fluid—i.e. thesuspension. In this phase, the instrument head 20 may occupy the statesuch as it is shown in FIG. 2B. The shuttle valve 25 locks the internalfeed canal 21 so that run on of the first fluid will be prevented.Following filling of the distal reservoir 24, in the third time intervalT3 the first fluid is conveyed with a pressure pl. Preferably, thispressure pl is significantly lower than the high pressure ph so thatgentle application of the suspension is done. In the third time intervalT3, the instrument head 20 again is in the state a, such as it is shownin FIG. 2A. The first fluid penetrates into the distal reservoir 24 anddisplaces the second fluid. That is, the first fluid is a propellant andis for expelling the second fluid at a given pressure pz. According tothe configuration, the distal reservoir 24 may be filled for anothertime in an application time interval (cf. fourth time interval T4) andthe suspension may be delivered for another time (cf. time interval T5).

FIG. 3A shows a further embodiment of the application instrument 10according to the invention. Contrary to the embodiment of FIGS. 2A and2B, in the embodiment according to FIG. 3A, another valve is provided inthe instrument head 20. Said other valve, a check valve 25′, as well asthe shuttle valve 25, is located in the external feed canal 22. Oppositeto the shuttle valve 25 the check valve 25′ is arranged in lesservicinity to the distal tip of the application instrument 10. The checkvalve 25′ is a rubber lip that completely locks the external feed canal22 in the pressure-free state. FIG. 3A shows a respective pressure-freestate, in which the first fluid is conveyed and is outputted via thenozzle 23.

In conveying the second fluid via the second inlet in the external feedcanal 22, the check valve 25′ opens and, as already illustrated, theshuttle valve 25 locks the lateral openings 26. A corresponding state isshown in FIG. 3B. In this state, the distal reservoir 24 may be filled.As soon as the fluid flow in the external feed canal 22 stops, the checkvalve 25′ closes. In this respect, the second fluid is prevented fromrunning on. If in the internal feed canal 21, the pressure exceeds thepressure of the distal reservoir 24, the shuttle valve 25 opens. Thismay result in that a very steep external edge may energetically becreated at the pulsed jet.

The described embodiment allows to be employed in particularadvantageously with a flexible nozzle 23, as it is exemplified in FIGS.4A and 4B. However, the flexible nozzle 23 may also be of advantage,independent from a check valve 25′ being present or not.

The flexible nozzle 23 according to FIG. 4A is closed in thepressure-free state. For this, the flexible nozzle body is incorporatedinto the application instrument 10 such that specific pressing radiallyacts on the nozzle body, locking the nozzle opening in the initialstate. If the pressure proximal of the nozzle body in the distalreservoir 24 increases, for example due to feeding the second fluid, thenozzle body is first slightly bent outwards without the nozzle beingopened (not shown). Thus, a defined volume amount in the distalreservoir 24 may be pre-dosed. Subsequently, the pre-dosed volume, suchas already described, with a subsequent high pressure pulse (cf. thirdor fifth time interval T3, T5) may be introduced into the canal that isopened in the tissue. The nozzle body described in this illustratingexample has a circumferential lip that tapers in the radial direction.The nozzle body may also be designed bisectionally. For example, thecircumferential lip may consist of a flexible material, while, at itsbase, it is enclosed by a support of hard material. The performance ofthe flexible nozzle 23, in particular the expansion thereof, in thepre-dosing and filling phase, respectively, crucially depends on thechoice of material and the extent of pressing in the incorporated state.According to the invention, the flexible nozzle 23 is configured suchthat sufficient expansion and thus accommodation of the pre-dosed volumein the distal reservoir 24 may be accomplished without the requirementof high pressure, for example higher than 20 bar. Moreover, the flexiblenozzle is configured such that, in the open state, the nozzle opening 23is large enough for a jet effect, i.e. sufficient acceleration of thefluid, to be allowed to be achieved.

The flexible nozzle 23 according to the invention may be employed forpreventing run on of the fluid following application of the first and/orsecond fluid. Simultaneously, at appropriate filling of the distalreservoirs 24, a certain preliminary pressure is saved, which then maybe retrieved. Moreover, the flexible nozzle 23 minimizes the risk ofclogging the application instrument 10. In the configuration accordingto the invention, clogging only results in increase of pressure, whichin turn causes expansion of the nozzle 23 such that polluting particlesmay pass.

FIG. 4B shows the instrument head 20 with the flexible nozzle 23 beingopen, for example within the third time interval T3.

FIG. 5 shows an alternative embodiment of the instrument head accordingto FIGS. 4A and 4B. Here, the external feed canal 22 is for feeding thefirst fluid, and the internal feed canal 21 is for feeding the secondfluid. The state shown in FIG. 5 for example occurs in the first timeinterval T1 if the first fluid is used for creating a tissue canal. Alsoin the other embodiments already described, according to the invention,the internal feed canal 21 may be used for the second fluid, and theexternal feed canal 22 may be used for the first fluid.

FIGS. 6A and 6B show another illustrating example according to theinvention, in which a flexible element is used as a second passivevalve. Different from the illustrating example according to FIGS. 2A and2B the application instrument 10 of FIG. 6A has a venting device 40 inthe second inlet. An essential component of the venting device 40 is theventing chamber 44, in which the second inlet 12 ends, a vent 41 and aventing valve 45. The function of the vent 41 is controlled by way ofthe venting valve 45. The vent 41 allows venting the second inlet 12 andthus venting at least a section of the external feed canal 22. If thesecond inlet 12 is pressurized, the venting valve 45 locks afterretrograde (sealing effect between the second inlet 12 and the vent 41).Distally from the venting valve 45 there is excess pressure in theventing chamber 44. Consequently, the second fluid may flow toward theinstrument head and may be delivered (for example during the third timeinterval T3). This state is shown in FIG. 6A.

If the pressure in the second inlet 12 declines, the venting valve 45 istransferred into its initial state and locks the proximal portion of thesecond inlet 12 against the venting chamber 44 (cf. state according toFIG. 6B). Simultaneously, the excess pressure in the distal area of thesecond inlet 12 is rapidly reduced via the vent 41. This results in thatrun on out of the nozzle 23 is stopped very fast, and ideally isprevented, since flow resistance in the vent 41 is significantly lowerthan that in the nozzle 23. In this respect, the pressure edge of thedelivered and pulsed fluid jet may very steeply decline. Since theshuttle valve 25, in this state, locks the external feed canal 22, onlyvery low amounts of the second fluid escape through the vent 41.According to the invention, it is conceivable to provide an apparatusfor receiving the substance exciting the vent and to occasionallyrecover the substance. It is understood that, according to theinvention, several vents 41 may also be provided.

In another illustrating example, the venting valve 45 is not a passiveone but is an active valve or a control valve, respectively. Forexample, in the handle 62 of the application instrument 10 a magneticvalve may be provided taking over the function of the venting valve 45.This magnetic valve may be controlled by supply system 50 (cf. FIG. 10).

FIG. 7A shows an embodiment of the application instrument 10, which inits mode of operation is similar to that of FIGS. 3A and 3B. The checkvalve 25′ is formed by a flexible element at an orifice of the secondinlet 12 leading into the external feed canal 22. The flexible elementis designed such that, in a non-represented initial state, pressing tolock the second inlet 12 is provided. The strain accomplished therewithproduces sealing effect in the pressureless state. If the second inlet12 is pressurized, the flexible element deforms (cf. representation ofFIG. 7A) such that it opens the fluid communication leading to theexternal feed canal 22. If the pressure in the second inlet 12 decreasesagain, the reset forces, after lower deviation of a specific pressurethreshold, reset the flexible element into the initial state, and thecheck valve 25′ closes.

In an illustrating example, the flexible element is composed of aflexible tubing section. By applying reinforcing structures, such as forexample the ribs 5 shown in FIG. 7B extending in the direction of thelongitudinal axis and/or reinforcing fibers 6 of a relatively stiffmaterial, stronger pressing and consequently higher locking force of thecheck valve 25′ may be accomplished.

FIG. 8A, 8B, 8C show different embodiments of the shuttle valve 25. In apreferred embodiment, it is formed by a flexible material that isarranged at the outer side of the internal feed canal 21 thus lockingthe lateral openings 26 ending in it.

The embodiment according to FIG. 8A shows flexible tubing 30 that isarranged sectionwise over the distal end of the internal feed canal 21.Fixing of the flexible tubing 30 is done through a clamp ring 31. Onesignificant aspect of the embodiment according to FIG. 8A resides inthat the flexible tubing 30 partially projects over the distal end ofthe internal feed canal 21. Finally, a first section 34, to which theflexible tubing on the internal feed canal 21 abuts and a second section35, in the course of which the flexible tubing 30 tapers, result.Accordingly, the flexible tubing 30 extends over a sealing edge 32having exceptionally high surface pressure. In this way, a superiorsealing effect is achieved.

In the embodiment according to FIG. 8B, the internal feed canal 21sectionwise has a radial outwardly projecting bulge. This bulge isarranged at the location where the lateral openings 26 are located.Proximally and distally to the bulge, the internal feed canal 21 has alower diameter. Consequently, in regard of the flexible tubing 30, afirst section 34 with larger diameter, a second section 35 with lowdiameter and a third section 36 with low diameter result. The diameterof the second and third sections 35 and 36 may be identical. In anotherillustrating example (not represented) the diameter of the second andthird sections 35 and 36 may also have different values. By way ofdifferent diameters of the first 34 and second 35 and/or third 36sections a sealing edge 32 is created that increases the lockingfunction of the shuttle valve 25. Furthermore, the larger diameter inthe first section 34 causes preliminary extension and pre-tensioning ofthe flexible element, which also causes a superior sealing effect.

Higher surface pressure may also be achieved by the cylinder segmentssurrounding the lateral openings 26 of the internal feed canal 21 (cf.FIG. 8C). Finally, said cylinder segments also form sealing edges 32,which increase the locking function of the valve.

FIGS. 9A and 9B show further embodiments of the application instrument10, in particular of the instrument head 20. Herein, the probe shaft 14is a multi-lumen tubing (a two-lumen tubing is shown). Thus, in thisillustrating example there are no canals that are coaxially arranged toeach other, and comprising the internal feed canal 21 and the externalfeed canal 22. Instead, a first feed canal 21′ for the first fluidextends parallel to a second feed canal 22′. Between the first inletcanal 21′ and the second inlet canal 22′ a separation wall 28 isprovided. In the illustrating example shown, the cross section area ofthe first feed canal 21′ is significantly different from that of thesecond feed canal 22′. For example, the first feed canal 21′ may have across section area twice as large as that of the second feed canal 22′.These significantly differing cross section profiles may assure thatdifferent volume flows, e.g. different volumetric flow rates, (accordingto the invention the volume flow of the first fluid is larger than thatof the second fluid) will be considered. According to the invention, thecross section profile of the first feed canal 21′ may be more than twiceas large as the cross section profile of the second feed canal 22′.

In the embodiment according to FIGS. 9A and 9B, the first feed canal 21′tapers at the distal end and then ends in a significantly broader distalreservoir 24 that is in immediate fluid communication with the nozzle23. A side opening 26 of the second feed canal 22′ laterally endsapproximately in the middle of the tapering section of the first feedcanal 21′. In the tapering section (=holder) a flexible element forforming a lip check valve 25 is arranged. Finally, a bidirectional valveresults therefrom, which takes the function of the already describedshuttle valve 25. The lip check valve is preferably axially mounted inthe first feed canal 21′ by the holder of a hard (non-flexible)material. The internal contour of the tapering section largelycorresponds to the outer contour of the distal portion of the lip checkvalve. At this time, the opening of the tapering section is dimensionedsuch that, in the initial state (the flexible element is such as shownin FIG. 9A, i.e. not expanded) a gap results between the lips of theflexible element and the internal wall of the holder. For example, ifthe first fluid flows through the first inlet canal 21′, the distalsection of the flexible element—the lips of the valve—becomes expanded,so that it will be opened above a pressure threshold, and the firstfluid may enter into the distal reservoir 24. Simultaneously, the lowervalve lip is pressed against the wall of the tapering section by thepressure. Thus, the flexible element locks the side opening 26 from thesecond feed canal 22′. The pressure conditions of the first feed canal21′, in this state, are decoupled from the pressure conditions of thesecond feed canal 22′. If the pressure in the first feed canal 21′declines (for example after the first time interval T1), the shuttlevalve 25 returns to the initial state, so that the side opening 26, asit is shown in the FIG. 9B, will be released. In the second timeinterval T2, the second fluid may pass through the gap almostunhamperedly, so that filling of the distal reservoir 24 at low pressureis possible. Since the flexible element now operates in the lockingdirection, it again acts as a barrier between the first feed canal 21′and the second feed canal 22′. Preferably, the gap is dimensioned suchthat the second fluid may unhamperedly flow at low pressure, and on theother hand the shuttle valve 25 is safely locked, so that to avoidentering of the second fluid into the first feed canal 21′.

The same effect (bidirectional valve effect) may also be achieved by theuse of an internal acting valve in combination with a ball valve. Bothvalves are sequentially arranged in a lumen (preferably in the biggerone). Meanwhile, the ball valve is located proximal in relation to theflexible element. In this arrangement each one of the valves performslocking of the fluid in each one of the direction, while flow isunhamperedly maintained in each one of the other directions.

All the embodiments described so far have the object of the invention toaccomplish different pressure levels in the first feed canal 21′ and theinternal feed canal 21, respectively, and the second feed canal 22′ andthe external feed canal 22 respectively. For this, the canals aredecoupled from each other with the help of valves. At the same time, useof passive valves in the form described allows suppression of run on aswell as realization of a pressure reservoir function. These twofunctions are in particular advantageous in combination with the use ofproximally deployed active valves. In the following, several supplysystems 50 of the invention for operating the described applicationinstruments are described. According to the invention, the supply system50 may also be used with other application instruments 10, for examplecommon application instruments, to achieve the advantageous effectsdescribed below.

FIG. 10 shows supply system 50, through which the first inlet 11 and thesecond inlet 12 are connected to the described application instrument10. In the illustrating example shown in FIG. 10, in the second inlet, amedium separation device 60 is provided, so that the supply system maydeliver the first fluid, preferably saline, through differentconnections, wherein, depending on the selected inlet, different fluidsmay finally arrive at application instrument 10 (in the first inlet 11the first fluid and in the second inlet 12 the second fluid).

The supply system 50 comprises a controller, which implements a controlprocess, in which, within one application time interval, there areperformed the steps of:

conveying the first fluid during the first conveying interval T1 withthe high pressure ph into the first feed line 11;

indirectly conveying the second fluid during the second conveyinginterval T2 with the second pressure pz in the second feed line 12 whileusing the medium separation device 60; and

conveying the first fluid during of the third conveying interval T3 withthe third pressure pl in the first feed line.

According to the invention, the control process may be designed foradditionally offering an appropriate control strategy during the fourthconveying interval T4 and the fifth conveying interval T5 (cf. FIG. 17).

For the realization of the control process the controller 51 interactswith a fluid source for example of a pump 52, a first control valve 55and a second control valve 55′.

The pump 52 is in fluid communication with a pressure reservoir 53 ofthe supply system 50. In the illustrating example shown the pump 52operates continuously and is flow-controlled. Control of the firstcontrol valve 55 which is in fluid communication with the pressurereservoir 53 allows setting a desired pulse shape (frequency, dutyfactor, effective pulse performance). Flow control of the pump causesconstant volume flow of the first fluid within the supply system 50independent of the switching position of the first control valve 55.

The first control valve 55 preferably is a 3/2-way valve, which, in theenergized state, establishes fluid communication between the pressurereservoir 53 and a second control valve 55′ via a pressure duct 54. Thefirst control valve 55 essentially serves for building up a desiredpressure level, whereas the second control valve 55′ applies the setpressure level to the first inlet or the second inlet 12.

Under electroless condition (cf. representation according to FIG. 10) ofthe first control valve 55 there is a fluid communication between thepressure reservoir 53—and consequently also with the pump 52—and a firstbypass duct BY1. The fluid flow is discharged via the bypass duct BY1 sothat no illicit operating condition for the pump 52 will occur.Preferably, the first bypass duct BY1, as it is shown in FIG. 10, isprovided with a with a throttle valve 58 that provides for a certainpressure level to be maintained in the upstream system section or thefirst control valve 55. For setting this pressure level, a hydraulicresistance at the throttle valve 58 may be set manually or via thecontroller 51 (cf. FIG. 13). In the illustrating example shown in FIG.10 the resistance is preset. In the state shown in FIG. 10 in thepressure reservoir 53 a pressure level is set that is preset by thethrottle valve 58. As soon as this pressure level is applied via thefirst control valve 55 to one of the two inlets 11, 12, the pressure inthe respective inlet rebounds. In this respect, a fluid pulse with asteep edge may be emitted. According to the invention, it is thuspossible, to attain a pressure level p′max during a bypass phase ÜD1,ÜD2 (cf. FIG. 19) that exceeds the desired pressure, for example thefirst pressure ph or the third pressure pl. Said pressures arepreferably set via the efficiency of the pump 52. This pressure increaseresults in that the pressure pulse expands very fast in the lines. Inthis respect, a very steep pulse edge may be achieved at the nozzle 23.Furthermore, excess pressure may compensate loss of pressure in theinlets 11, 12. However, excess pressure must be selected such that fastincrease of force is achieved, whereas the desired pressure at thenozzle 23 is not exceeded.

Starting from the first control valve 55, in the energized state (notshown) the pressure expands via the pressure ducts 54 to the secondcontrol valve 55′. In the illustrative example described, the secondcontrol valve 55′ selects an inlet 11, 12.

In another illustrating example, the effect of excess pressure may beused to perform initial perforation of the biological tissue as apreliminary step for the following substance input. In this illustratingexample, the supply system thus generates a steeply increasing pressureprofile that declines with the time. The second control valve 55′ is setsuch that during the course of the declining pressure edge, perforationof the tissue (first time interval T1) is performed first, and thenfilling of the distal reservoir 24 (second time interval T2) and finallyinput of the substance (third time interval T3) is performed.

In a further illustrating example (cf. FIG. 11), the second controlvalve 55′ is integrated in the instrument 10. Preferably, control of thesecond control valve 55′ is still done via the controller 51. In afurther preferred illustrating example, the first control valve 55 isadditionally incorporated into the application instrument as well.Preferably, respective incorporation in a handle 62 of the applicatorinstrument 10 is done. By this, the pressure pulses may be preventedfrom being attenuated through long and/or flexible feed lines. Accordingto one aspect of the present invention, arrangement of the requiredcontrol valves 55, 55′ is as close as possible at or within theapplication instrument 10.

In one embodiment, the arrangement of the first control valve 55 isselected such that, in the electroless state, it locks communicationbetween the pressure duct 54 and the pump 52. The pressure duct 54 isthus pressureless during the bypass phases ÜD1, ÜD2 or is pressurizedwith residual pressure, respectively. This arrangement has twoadvantages: On the one hand, the first control valve 55 is required tobe energized only for a short time during activation for the delivery ofa pulse sequence. On the other hand, the pressure level set by thethrottle valve 58 is already available at the first pulse that isdelivered.

FIG. 12 represents another embodiment for effectively generating fluidpulses. In this embodiment, a 2-way valve is used as a first controlvalve 55. As in the above-described embodiment, there is fluidcommunication between the pump 52 and the pressure reservoir 53.Furthermore, there is fluid communication by way of a 2/2-way valve fromthe pressure reservoir to the first control valve 55.

Furthermore, there is fluid communication from the pressure reservoir 53to a relief valve 59 in the first bypass that is followed by adownstream throttle valve 58. The 2/2-way valve is for delivery of awater jet pulse with preset duration, whereas the relief valve 59 allowsgeneration of a desired pressure level during the bypass phases ÜD1 ÜD2.For this, the relief valve 59 may be set such that, upon reaching aspecified pressure, it releases the first bypass duct so that thepressure may be reduced. The relief valve 59 may function as acontroller that preferably is controlled by the controller 51. Inanother aspect, the pressure-pressure flow characteristic curve of therelief valve 59 may be designed such that during passing the valve somepressure declines at the valve. In one embodiment, the relief valve 59is completely omitted.

FIG. 13 shows a further illustrating example, wherein two 2/2-way valvesare employed. Finally, the first control valve 55 is designed as a2/2-way valve still serving for controlling proliferation of thepressure present in the system to the application instrument 10. A thirdcontrol valve—that is as well a 2/2-way valve—allows pressure settingwithin the system by way of releasing or locking the first bypass BY1.The third control valve 55″ may essentially contribute to building upsome excess pressure.

In order to reduce, after delivery of a pulse, the fall time, a furtherbypass duct BY2 may be provided on the flow-averted side of the firstcontrol valve. FIG. 14 shows a respective embodiment of the valvearrangement in an initial state, wherein the valves are controlledaccording to the application step. A fourth control valve 55′ allows forrapid and specific reduction of the present pressure in the inlets 11,12′. This embodiment allows realization of venting phases ENT1, ENT2, asit is shown in FIG. 19. In the embodiment shown in FIG. 14 is thuspossible to build up excess pressure in a first bypass phase ÜD1 and tospecifically transfer it to the application instrument 10 so that, atthe nozzle 23 thereof, a pulse with an edge as steep as possible isemitted. Subsequently, the pump 52 further drives the fluid to maintainthe first pressure during the first time interval T1. Subsequently, thefirst control valve 55 is locked to terminate the pulse (point of timet2). At the same time, the fourth control valve 55′″ is opened to createfluid communication with the second bypass duct BY2. In this way, thefirst venting phase ENT1 is implemented. The fall time is very lowleading to direct pressure reduction, for example in the distalreservoir 24. Analogously, during the third time interval T3—applicationof the suspension—a pulse edge as steep possible at the beginning(bypass phase ÜD2) and at the end (venting phase ENT2) may be achieved.

FIG. 15 shows an illustrating example, in which a 2/2-way valve is usedas first control valve 55. The 2/2-way valve is integrated in the bypassduct BY1, whereas the application instrument 10 is directly connected tothe pump. An advantage of this design resides in that with it alsoventing phases ENT1, ENT2 may be implemented for faster pressurereduction. In comparison to the embodiments previously described thisembodiment is very simple and stable.

FIG. 16 shows a further illustrating example of the supply system 50according to the invention. Herein, two 3/2-way valves are employed torealize the already described functionality.

The described active valves and control valves, respectively, may havean electromagnetic drive or another drive known in the art. For example,piezo actors, a pneumatic drive unit or analogues may be used.Furthermore, the embodiments may be combined with each other in anymanner. For realization of the invention, needle valves, membranevalves, rocker valves and others may be employed. For realization of thedescribed 2/2-way valves for example a clamp valve may be employed,which is preferred due to its sterilisability.

FIG. 17 and FIG. 18 show different pressure histories, each having apulse for perforation of the tissue (=first time interval T1) and twopulses for application of the substance (=third and fifth time intervalT3 and T5). The second time interval T2 is used to fill the distalreservoir 24. According to FIG. 17, refill of the distal reservoir 24 isdone in the fourth time interval T4. According to FIG. 18, a respectiverefill is omitted.

FIG. 19 shows the time arrangement of the bypass phases BY1, BY2 and ofthe venting phase ENT1, ENT2 in relation to the time intervals T1through T5. The first bypass phase terminates with the beginning of thefirst time interval T1 at the time t1. The first venting phase ENT1starts at the end of the first time interval T1 at the time t2. In theinterval between t2 and t3 the second bypass phase BY2 starts, whichterminates at the time t3 with the beginning of the third time intervalT3. At the end of the third time interval T3, at the time t4, the secondventing phase ENT2 starts, which terminates at the time t5.

LIST OF REFERENCE NUMBERS

-   1 Mucosa-   2 Muscularis-   3 Lamina propria-   4 Circular muscle-   5 Rib-   6 Reinforcement fiber-   10 Application instrument-   11 First inlet, first feed line-   12 Second inlet, second feed line-   14 Probe shaft-   20 Instrument head-   21 Internal feed canal-   21′ First feed canal-   22 External feed canal-   22′ Second feed canal-   23 Exit opening, nozzle-   24 Distal reservoir-   25 Shuttle valve-   25 Check valve-   26 Side opening-   28 Separation wall-   30 Flexible tubing-   31 Clamp ring-   32 Sealing edge-   34 First section-   35 Second section-   36 Third section-   40 Venting device-   41 Vent-   44 Venting chamber-   45 Venting valve-   50 Supply system-   51 Control-   52 Pump-   53 Pressure reservoir-   54 Pressure duct-   55, 55′ Control valve-   58 Throttle valve-   59 Relief valve-   60 Medium separation device-   100 Application system-   Ad External diameter-   BY1, BY2 Bypass duct-   ÜD1, ÜD2 Bypass phase-   ENT1, ENT2 Venting phase-   t1-t6 Point of time-   T1-T5 Time interval-   pz, pl, ph Pressure

What is claimed is:
 1. An apparatus for water jet application of firstand second fluids with an instrument head, the apparatus comprising: anexit opening (23) configured for water jet application of the first andsecond fluids for perforating a tissue with the first fluid only andinjecting the second fluid into the tissue, wherein the first and secondfluids are liquids; a first feed line (11) configured to feed the firstfluid only; a second feed line (12) configured to feed the second fluidonly; a reservoir (24) configured to store the second fluid fed via thesecond feed line (12), wherein the exit opening (23) is configured toretain the second fluid in the reservoir until expelled therefrom by thefirst fluid; wherein the reservoir (24) is in fluid communication withthe first feed line (11) and/or is adapted to be brought in fluidcommunication with the first feed line (11) via at least one valve (25)arranged in the instrument head, such that the first fluid causes thesecond fluid stored in the reservoir (24) to be expelled from the exitopening (23).
 2. The apparatus according to claim 1, wherein, when thereservoir (24) is adapted to be brought in fluid communication with thefirst feed line (11) via the at least one valve (25) arranged in theinstrument head, the at least one valve includes at least a locking partconfigured to lock the first feed line (11) against the reservoir (24).3. The apparatus of claim 2, further comprising a valve in the secondfeed line (12), wherein the valve in the second feed line is in additionto the at least one valve arranged in the instrument head and configuredto prevent back flow of fluid in the second feed line (12).
 4. Theapparatus according to claim 1, wherein, when the reservoir (24) isadapted to be brought in fluid communication with the first feed line(11) via the at least one valve (25) arranged in the instrument head,the at least one valve is configured to either lock the first feed line(11) or the second feed line (12) against the reservoir (24).
 5. Theapparatus according to claim 1, wherein the exit opening (23) comprisesa valve in the form of a flexible nozzle.
 6. The apparatus of claim 1,further comprising: a flexible shaft (14); an instrument handle in thevicinity of or at a proximal end of the shaft (14), wherein theinstrument head is arranged at a distal end of the flexible shaft (14).7. The apparatus according to claim 6, wherein the shaft (14) and/or theinstrument head has an outer diameter (Ad) of less than 3 mm.
 8. Theapparatus according to claim 6, further comprising a venting device (40)in or at the second feed line (12), wherein the venting device (40)comprises a venting valve (45) configured to vent the second feed line(12).
 9. The apparatus according to claim 6, wherein the instrumenthandle comprises at least one control valve with a valve driveconfigured to generate pulsed pressure in the first feed line (11)and/or the second feed line (12).
 10. The apparatus of claim 6, furthercomprising a supply system (50) that is in fluid communication with thefirst feed line (11) and is formed to convey, in a series of conveyingintervals (T1, T3, T5), the first fluid into the first feed line (11).11. The apparatus according to claim 10, wherein the supply system (50)comprises a controller (51) configured to control at least oneadditional valve (55) such that within an application time interval ofless than 2 s: the first fluid, during at least a first conveyinginterval (T1), is conveyed into the first feed line (11) with a firstpressure (ph); the second fluid, during a second conveying interval (T2)timely following the first conveying interval (T1), is conveyed into thesecond feed line (12) with a second pressure (pz); and the first fluid,during at least a third conveying interval (T3), is conveyed with athird pressure (pl) into the first feed line.
 12. The apparatusaccording to claim 11, further comprising: a pump (52) configured toconvey the first fluid.
 13. The apparatus according to claim 11, whereinthe first pressure (ph) is larger, by at least 30% of the third pressure(pl), than the third pressure (pl).
 14. The apparatus of claim 1,wherein the second fluid contains cells.